NUTRITION DURING LACTATION

NUTRITION DEPARTMENT
MEDICAL FACULTY OF SUMATERA UTARA UNIVERSITY
 Objectives
1. What is breastfeeding and its function
2. To know food sources that influence the
breastfeeding proccess
3. To know energy estimation and need
 Introduction

LACTATION PERIOD

Different human Breastfeeding is

milk volume for the best for the
each mother baby
BREASTFEEDING GOALS

Sources: American Academy of Pediatrics, 2012

 The immunologic components in
human milk
• Immunoglobulins
Human milk contains all of the different antibodies (M, A,
D, G, E), but secretory immunoglobulin A (sIgA) is the most
abundant;
• Lactoferrin which binds to iron, thus making it unavailable
to pathogenic bacteria;
• Lysozyme which enhances sIgA bactericidal activity
against gram-negative organisms;
• Mucins adhere to bacteria and viruses and help eliminate
them from the body;
• Leukocytes with the transition from colostrum to mature
milk, the percentage of macrophages increases from 40-
60% of the cells to 80-90%.
 BREAST FEEDING
• Exclusive breast-
feeding is
unequivocally the
preferred method of
infant feeding: first 4
to 6 months of life
• Give new born infants
no food or drink other
than breast milk
unless medically
indicated
 Breast-feeding an infant

• During last month pregnancy, counseling on

the process of lactation
Preparation • Fathers or partners participated
emotional support

• Learned skill for both mother and her infant

Technique • 48-96 hours after birth the breast become
fuller and firmer as the milk volume increase
 Human milk

Colostrum

Transitional milk

Mature milk
 COLOSTRUM
• Thin, yellow, milky fluid that is the first milk available
after birth
• Higher in protein and lower in fat and carbohudrate
than mature milk
• Provides 20 kcal/mL
• Lower inlactose than mature milk
• Facilitates the passage of meconium
• High in antioxidant
• Lower in water soluble vitamins, higher fat soluble
vitamins, protein, sodium, potassium, chloride, zinc,
and immunoglobulins
 TRANSITIONAL MILK

• It occurs after colostrum stage and lasts for

approximately two weeks until it is replaced
by mature milk.
• The transitional milk contains high levels of
fat, lactose, and vitamins to help the baby
regain any weight lost after birth .
• It contains more fat and lactose than
colostrum and has water-soluble vitamins.
 MATURE MILK
• It is the final milk that is produced and lasts
throughout lactation.
• Ninety percent is water, which is necessary to
maintain hydration of the infant. The other
10% is made up of carbohydrates, proteins,
and fats, which are necessary for both growth
and energy.
• There are two types of mature milk: foremilk
and hindmilk.
 Mature milk
The foremilk (the milk "in
front") is produced at
the beginning of each
feeding. It contains
water, vitamins, and
protein
The hindmilk is pushed
out latter , it is heavier ,
richer in lipid and CHO
 Maternal Energy
• Milk production is 80% efficient production of
100 mL of milk (75 kcal) requires 85 kcal
expenditures
• First 6 months: average milk production 550-1200
mL/day (average 750 mL/day)
• The DRI:
• + 330 kcal/day (first 6 months)
• + 400 kcal/day (second 6 months)
• For overweight and obese: +100-150 kcal/day
 Protein
• The DRI for protein: additional 25 g/day or 71
g/day (usually: 50-60 g/day)
• The average protein requirement: estimated
from milk composition data (750 mL/day
assuming 70% efficiency in the conversion of
dietary protein to milk protein)
• Breast milk has a whey/casein ratio of 90:10
(early lactation) 80:20 baby gets older
60:40 instead cow’s milk: 18:82
 Carbohydrate
• The RDA: 210 g/day
• Provide enough calories in the diet for
adequate volumes of milk and to maintain
adequate energy level
• Adjusted on activity of the mother and the
amount of breast feeding
• Poor gestation weight gain may require
carbohydrate
 Lipid
• The amount and type of fat in breast milk directly
reflects the maternal diet
• DRIs state a recommended amount of specific
long-chain polyunsaturated fatty acids fetal
and infant brain development
• Omega 6: 13 g/day
• Omega 3: 1.3 g/day
• The amount of cholesterol in milk does not
reflect the mother’s diethuman milk contains
10-20 mg/dL of cholesterol
Other Nutrient Needs During Lactation
• Vitamins and minerals
– Inadequacies reduce the quantity, not quality of breast
milk
• Quality maintained at expense of maternal stores
– Prolonged inadequate intakes
• Impacts several nutrients
– Vitamin D 200 IU (5 mcg) for 2 month of age. For the
mother4000 IU (100 mcg)
– Calcium: it is not related to maternal intake: 1600 mg/day
– Iodine: may nor reflect maternal intake; pollutant
perchlorate  inhibit iodine: cretinism
– Zinc: greater during lactation
– Iron
 Influence of diet on milk composition
• Protein-energy malnutrition impacts milk volume.
Composition remains relatively unaffected
• Water soluble vitamins move readily from serum to
milk thus dietary fluctuations are more apparent
– B12 vegan, case report of beri-berI
• Fat soluble vitamin content not improved with
supplementation
• Fatty acid composition (DHA and ARA) altered by
maternal diet and supplementation
 Breast milk composition and Diet
• DHA levels of breastmilk vary with diet. Increased
amounts of DHA have been found in the breaskmilk
of mothers consuming fish or fish oil, and with
suppleemntation.
• Water soluble vitamins may vary with diet. Diets
inadequate in B12 or thiamin have been associated
with case reports of deficiency in infants. High
intakes of Vitamin C, however, does not apear to
change the content of breastmilk.
• Supplementation of fat soluble vitamins do not
appear to alter the content of breastmilk
• Iron supplementation does not appear to alter the
iron content of breastmilk
 Breast milk and allergy
– maternal restriction of cow's milk, egg,
fish, peanuts and tree nuts and if this is
unsuccessful,
– use of a hypoallergenic (extensively
hydrolyzed or if allergic symptoms
persist, a free amino acid-based formula)
as an alternative to breastfeeding.
Thank you